FASD signs a nurse should watch for in a young child

When a child's early difficulties trace back to prenatal alcohol exposure, an observant nurse can be the first to open the door to the right support.

In short

Fetal Alcohol Spectrum Disorder (FASD) results from prenatal alcohol exposure and shows up as a mix of growth, facial, neurological and developmental features that vary widely between children. A nurse should watch for the combination of poor growth, characteristic facial features, and developmental or behavioural difficulties — no single sign is diagnostic, but a pattern, especially with a known or suspected exposure history, warrants onward referral. FASD is preventable but lifelong, and early identification meaningfully improves outcomes.

Signs to watch for

FASD presents along a spectrum, so look for clusters rather than isolated features:

• Growth — low birth weight, poor weight gain, short stature or persistently small head circumference (microcephaly).
• Facial features (most specific when all three co-occur) — short palpebral fissures (small eye openings), a smooth philtrum (the groove between nose and upper lip) and a thin upper lip.
• Neurodevelopmental signs — developmental delay, poor coordination and fine-motor difficulty, feeding and sleep problems in infancy, and later difficulties with attention, memory, learning and self-regulation.
• Behaviour and adaptive function — hyperactivity, impulsivity, difficulty understanding consequences, trouble with daily-living and social skills disproportionate to apparent ability.
• Sensory and regulation — irritability, sensitivity to stimulation, and difficulty settling.

Document any maternal alcohol history sensitively and without blame — it is a clinical detail, not a judgement.

When to refer

Refer for a structured developmental and paediatric assessment when you observe a cluster of growth, facial and neurodevelopmental features — particularly alongside any history of prenatal alcohol exposure. Confirmed or strongly suspected exposure with developmental concern is itself sufficient reason to refer, even without the full facial triad. Early referral allows diagnosis, support for learning and behaviour, and family guidance well before school demands escalate.

The Pinnacle way

AbilityScore® is part of Pinnacle’s developmental assessment. Diagnosis, where needed, requires an appropriately qualified healthcare professional — never from a checklist or an app. Our clinician-administered structured assessment builds a precise developmental profile across communication, motor, cognitive and adaptive domains, drawing on a network spanning 70+ centres and 700+ therapists. Learn how the AbilityScore® is formed, explore our occupational therapy support for regulation and daily-living skills, or return to our home for the full range of developmental support.

Trusted sources

WHO ICD-11 framing of fetal alcohol spectrum disorders; CDC guidance on FASD signs and prevention; American Academy of Pediatrics (HealthyChildren.org) guidance on recognising and supporting affected children.

Next step — Spotted a pattern of concern? Refer the family for a structured Pinnacle assessment so support can begin early.

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.